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Caring, Compassionate

Ontario’s Paramedics

Bringing Emergency Medicine to You

Critical Care - CCTU

The Critical Care
Transport Unit or CCTU as it's commonly referred to, is a program staffed by
TPA (Toronto Paramedic Association) member Paramedics employed by Toronto
Paramedic Services.

Founded in 1998 as
a Paramedic/Paramedic crew configured Team, the CCTU program has developed into
a successful and sought after resource. When time is critical and your patient
is critical, they are the team to call. The 14-member team
brings knowledge, skill, experience, and compassion to the patient care arena bridging
the gap between initial care and definitive care.

The team
specializes in the care of Adults, Paediatrics, High Risk Obstetrics,
Intra-aortic balloon pump, and shared care ECMO/ECLS (Extracorporeal Life
support).

A range of
drugs/pharmacology in excess of 100 are also part of their scope.
Administration can be via any desired route, inhalation, bolus or infusion. The
drug classes are inclusive of but not limited to: Antiarrhythmics, nitrates,
anti hypertensives, sedatives, pain control, anti-nausea, antibiotics,
inotropes, tocolytics, bronchodilators, paralytics, steroids, as well as blood
and blood products.

With special
funding from the Provincial government the team although based in Toronto is a
regional asset.

Completing approx.
1300 to 1400 calls per year the team makes a significant contribution to the
spectrum of care for some of the sickest and most injured patients in the Regional
Health Care System.

Operating from a
Base in the north end of Toronto provides the team excellent multi-highway
access. This access enables rapid response times. The team provides 24/7
coverage to stakeholder hospitals in metropolitan Toronto and the surrounding
area.

The team is
primarily dedicated to Critical Care calls, however they do respond to 911
calls as well when the situation warrants.

The 14 member team
each hold dual Paramedic certifications to enable their practice as both a
Critical Care Paramedic (certified by ORNGE) and as an Advanced Care Paramedic (certified by Sunnybrook Base Hospital).

Annual CME's,
clinical time, self study, and re-certification keeps them current and capable
in all their areas of responsibility. The Paramedics practice is enabled by a
set of Medical Directives. They can also access an established group of
Emergency, ICU and OBS physicians associated with their program for direct
Medical Delegation.

CRITICAL CARE
PAEDIATRIC TRANSPORT is part of the CCTU scope of care.

The team provides
care to paediatric patients from 28 days old or as low as 5 kgs up to their
transition into adults.

No child is too
sick or injured for this team to provide care and transport.

The team is called
into Stakeholder hospital E/R's, ICU's, Operating Rooms, and Paediatric units
to provide Critical care and Transport to definitive care. Many times in
assessing and preparing the child for transport they initiate or continue
further resuscitation and stabilization.

The two main receiving children's tertiary
care hospitals that the Team transports to are The Hospital for Sick Children
in Toronto and McMaster Children's Hospital in Hamilton. The Team utilizes a
skill set, medical equipment and a range of pharmacology to appropriately
manage their paediatric population of patients. The Paramedics practice in this
area is enabled by a set of Medical Directives. They also have access to an
established group of Emergency and ICU peadatricians associated with their program
for direct Medical Delegation. Like other areas of their practice they
participate in CME's, self-study, in hospital clinical shifts, and
recertification's specific to Paediatrics.

The team's goals
are quality patient care, and safe transports with a low threshold for adverse
events consistent with that of all other specialized paediatric transport teams
around the globe.

ECMO/ECLS
(Extracorporeal Membrane Oxygenation/Extracorporeal Life Support) Care and
Transport is an emerging specialty requirement within our large Regional
jurisdiction. 24 hours a day 7 days a week any of our on-duty CCTU Paramedic crews
can form the Adult Joint ECMO/ECLS care and transport team. This Joint 5 member
team consists of 2 Critical Care Paramedics, and from Toronto General Hospital
(UHN) 1 Intensivist, 1 surgeon, and 1 Perfusionist.

The
team assembles and responds in a CCTU ambulance to hospitals in the region that
request this level of care for one of their inpatients. Within those hospitals
the team could encounter that patient in the ER, OR, ICU or the CCU.

The
target patient types either have a Respiratory or Cardiac pathology that is
refractory to standard conventional treatments available at the hospital they
are in.

The
team roles have evolved and are well defined. The Intensivist Leads the team,
the surgeon places the ECMO/ECLS lines, the Perfusionist runs the ECMO/ECLS
machine. The Critical Care Paramedics are responsible for the overall logistics
of the call, all the pharmacological infusions, bolus drugs, blood products,
mechanical ventilation, and all the invasive and non-invasive monitoring
cardiac, respiratory and hemodynamic. As well, the paramedics complete the
patient care documentation.

Due
to the dynamic nature of this type of call the Critical Care Paramedics are
enabled by a very broad range of medical directives to optimize time and care
within the shared care join team model.

Once
the patient is successfully on ECMO/ECLS and is stable the team transports them
from the referring hospital to the Medical Surgical ICU at Toronto General
Hospital (UHN).

The
Critical Care Paramedics have received formal education in ECMO/ECLS by the
team of Intensivist and Perfusionist they work with out of Toronto General
Hospital (UHN).

As
the existence of this team and its capability becomes more known, the ECMO/ECLS
call volume has steadily increased year over year since 2013.

The is responsible for promoting the practice of Paramedicine and
ensuring the highest level of care for our patients. We are leaders in the advancement of Paramedicine and
achieve our objectives through public awareness, research and education. We lobby for self-regulation under
the Regulated Health Professions Act. We also assist in fund-raising for community-based charities. The
is a proud chapter of the Ontario Paramedic Association and the Paramedic Association
of Canada. The () is not a labour union.